OBJECTIVES: Optimum treatment for acute aortic dissection (AAD) with a thrombosed false lumen (thrombosed AAD) remains controversial. We evaluated the outcome of thrombosed AAD according to treatment strategy. MATERIALS AND METHODS: We examined 280 patients with AAD, of which 30 had thrombosed AAD. We compared computed tomography findings, cardiac performance, and clinical course in 28 of these patients. Patients were divided into three groups for the comparison: Group E (emergency surgery), Group C (conservative therapy), and Group S (conservative therapy switched to emergency surgery). RESULTS: In Group E (n = 13), one patient died and 12 survived. In Group C (n = 10), all patients were discharged, of which two died of cancer and two of the remaining eight survivors underwent subsequent elective surgery. In Group S (n = 5), one patient died and four survived following surgery. CONCLUSIONS: It was hard to predict re-dissection or rupture following conservative treatment for thrombosed AAD. Basically, we should perform emergency surgery following the diagnosis of thrombosed AAD, particularly in complicated cases such as those with pericardial effusion, tamponade, and large aorta. Conservative therapy has a very limited application in patients with the initial stages of thrombosed AAD.
OBJECTIVES: Optimum treatment for acute aortic dissection (AAD) with a thrombosed false lumen (thrombosed AAD) remains controversial. We evaluated the outcome of thrombosed AAD according to treatment strategy. MATERIALS AND METHODS: We examined 280 patients with AAD, of which 30 had thrombosed AAD. We compared computed tomography findings, cardiac performance, and clinical course in 28 of these patients. Patients were divided into three groups for the comparison: Group E (emergency surgery), Group C (conservative therapy), and Group S (conservative therapy switched to emergency surgery). RESULTS: In Group E (n = 13), one patient died and 12 survived. In Group C (n = 10), all patients were discharged, of which two died of cancer and two of the remaining eight survivors underwent subsequent elective surgery. In Group S (n = 5), one patient died and four survived following surgery. CONCLUSIONS: It was hard to predict re-dissection or rupture following conservative treatment for thrombosed AAD. Basically, we should perform emergency surgery following the diagnosis of thrombosed AAD, particularly in complicated cases such as those with pericardial effusion, tamponade, and large aorta. Conservative therapy has a very limited application in patients with the initial stages of thrombosed AAD.
Entities:
Keywords:
AAD with a thrombosed false lumen (thrombosed AAD); acute aortic dissection (AAD); conservative therapy; surgical treatment
Authors: P G Hagan; C A Nienaber; E M Isselbacher; D Bruckman; D J Karavite; P L Russman; A Evangelista; R Fattori; T Suzuki; J K Oh; A G Moore; J F Malouf; L A Pape; C Gaca; U Sechtem; S Lenferink; H J Deutsch; H Diedrichs; J Marcos y Robles; A Llovet; D Gilon; S K Das; W F Armstrong; G M Deeb; K A Eagle Journal: JAMA Date: 2000-02-16 Impact factor: 56.272
Authors: Anthony L Estrera; Zsolt Garami; Charles C Miller; Eyal E Porat; Paul E Achouh; Jayesh Dhareshwar; Riad Meada; Ali Azizzadeh; Hazim J Safi Journal: J Thorac Cardiovasc Surg Date: 2006-12 Impact factor: 5.209
Authors: Rajendra H Mehta; Toru Suzuki; Peter G Hagan; Eduardo Bossone; Dan Gilon; Alfredo Llovet; Luis C Maroto; Jeanna V Cooper; Dean E Smith; William F Armstrong; Christoph A Nienaber; Kim A Eagle Journal: Circulation Date: 2002-01-15 Impact factor: 29.690